General Surgery Coding Alert

Reporting hernia repair requires so much anatomy and physiology know-how that it's enough to confound even the most seasoned surgery coders.

Use our two handy tools to help you pick the right ICD-9 and CPT^® codes -- every time.

Tool 1: Anatomy and Diagnosis Chart

Use the following anatomy drawing and diagnosis coding chart to help you perfect your hernia claims for now and for the future when you're required to use ICD-10.

Tool 2: Glossary of Hernia Terms and Procedure Codes

Clinicians identify hernias primarily by location as outlined in tool 1. But there's often more to it than location -- like how the hernia forms and the clinical significance of the specific condition.

Study the following hernia definitions to learn the laparoscopic and open repair procedure code ranges for each type:

• Epigastric: An epigastric hernia is usually through anterior wall fascia, above the umbilicus and below the zyphoid, says M. Tray Dunaway, MD, FACS, CSP, a surgeon, author, speaker and coding educator with Healthcare Value Inc. in Camden, S.C. These hernias occur because of weakness in the muscles in the upper-middle abdomen.

Open: 49570-49572 (Repair, epigastric hernia ...)

Laparoscopic: 49652-49653 (Laparoscopy, surgical, repair ventral, umbilical, spigelian, or epigastric hernia ...)

• Umbilical: The fascia of the navel is thinner than in the rest of the abdomen. An umbilical hernia occurs when abdominal contents protrude from the navel.

Open: 49580-49587 (Repair, umbilical hernia ...)

Laparoscopic: 49652-49653

• Inguinal: In this common form of hernia (75 percent of all hernias are inguinal), the intestine bulges through a weak area in the inguinal canal in the groin area.

Open: 49491-49525 (Repair, ... inguinal hernia ...)

Laparoscopic: 49650-49651 (Laparoscopy, surgical, repair ... inguinal hernia)

• Femoral: These hernias occur in the area between the abdomen and the thigh, usually appearing as a bulge on the upper thigh.

Open: 49550-49557 (Repair, ... femoral hernia)

Laparoscopic: 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy)

• Incisional: An incisional hernia occurs as a defect in the abdominal wall at the site of a previous operative incision. The terms "'incisional' and 'ventral' hernia are often used interchangeably," says Gary W. Barone, MD, a physician and associate professor at the University of Arkansas for Medical Sciences in Little Rock.

Open: 49560-49566 (Repair, ... incisional or ventral hernia ...)

Laparoscopic: 49654-49657 (Laparoscopy, surgical, repair ... incisional hernia ...)

• Hiatal: "In general terms, hiatus hernia refers to herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm, and the main clinical implication is the propensity to develop gastroesophageal reflux disease (GERD)," Barone says. More than 95 percent of hiatal hernias are classified as "sliding" hernias, while the remaining 5 percent represent three different types of paraesophageal hernias, according to Barone.

Open: 43332-43337 (Repair, paraesophageal hiatal hernia ...)

Laparoscopic: 43281-43282 (Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed...)

For each code range, you may need additional information such as patient age and treatment encounter (initial or subsequent). Here are some more helpful terms you can use to narrow your code choice:

• Reducible -- The contents of a reducible hernia can be pushed back through the fascial defect.
• Incarcerated/Strangulated -- The contents of an incarcerated or strangulated hernia are trapped in the hernia sac and cannot be pushed back through the fascial defect.